Ahmed Sayed M, Abd Al-Rhim Somaya K, Mohamedani Ahmed A, Habour Ali B, Sadek Ali A
Department of Obstetrics and Gynecology, College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
Saudi Med J. 2002 Jun;23(6):684-8.
The aim of this study is to investigate the impact of plasmodium falciparum infection in parturient women in Central Sudan where malaria transmission is mesoendemic. The purpose of this paper is to find out the prevalence of malaria parasitemia and the risk of anemia among parturient women and to suggest appropriate strategies to lower their prevalence rates.
This prospective study was conducted at Medani Teaching Hospital, Sudan, a tertiary regional referral center, during the period January 1997 through to December 1997. All cases were admitted during labor to the delivery room and were clinically suspected to have malaria. History, examination and investigations were carried out on all patients.
The total number of patients enrolled in this study was 550, amounting to 14.9% of all women (N=3,687) who delivered during the study period. The prevalence of malaria parasitemia was 58.9% (N=550) while prevalence of anemia (defined as hemoglobulin <9.0 g/dl) was 24.1%. The mean hemoglobulin levels in patients with positive and negative malaria parasitemia was 9.72 1.62 and 9.85 1.60 g/dl. Statistically the difference in the mean hemoglobulin level was not significant, t=0.879, (P>0.05). A significant negative correlation between parasite count in maternal blood and hemoglobulin level of the mother, was observed, where r=-0.121 (P=0.032). Out of 17 (3.3%) patients who had used chloroquine tablets for prophylaxis, 11 patients still had positive parasitemia. Although there was a higher parasite count in those 11 patients, statistically the difference was not significance where P> 0.05.
The study documents a high prevalence of malaria parasitemia and anemia among the parturient women in Central Sudan. There were 533 pregnant women (97%) who did not use chloroquine tablets as chemoprophylaxis and 17 (3%) had prophylaxis. Eleven of the later (N=17) had positive parasitemia. In view of the high prevalence of parasitemia and anemia, and although the sample of patients who used chloroquine tablets for prophylaxis and had positive parasitemia is small (17 out of 550), a wide scale prophylaxis placebo-controlled trial is recommended to test the impact of prophylactic drugs in pregnancy and to measure the effect on the mother, and the neonate. The drug that proves to be effective as a prophylactic, should be an integral part of ante-natal care along with iron and folic acid as anti-anemic therapy. Moreover, prompt treatment of malaria infection with the appropriate anti-malarial drug, spray of insecticides and the use of insecticide-impregnated bed-nets and curtains for preventing malaria are recommended.
本研究旨在调查苏丹中部疟疾传播为中流行程度地区产妇感染恶性疟原虫的影响。本文的目的是查明产妇疟疾寄生虫血症的患病率以及贫血风险，并提出降低其患病率的适当策略。
这项前瞻性研究于1997年１月至1997年12月在苏丹迈达尼教学医院进行，该医院是一家三级区域转诊中心。所有病例在分娩时被收入产房，临床上怀疑患有疟疾。对所有患者进行了病史、检查和调查。
本研究纳入的患者总数为550例，占研究期间分娩的所有妇女（N = 3687）的14.9％。疟疾寄生虫血症的患病率为58.9％（N = 550），而贫血患病率（定义为血红蛋白<9.0 g/dl）为24.1％。疟疾寄生虫血症阳性和阴性患者的平均血红蛋白水平分别为9.72±1.62和9.85±1.60 g/dl。统计学上，平均血红蛋白水平的差异不显著，t = 0.879，（P>0.05）。观察到母体血液中的寄生虫计数与母亲的血红蛋白水平之间存在显著的负相关，r = -0.121（P = 0.032）。在17例（3.3％）使用氯喹片进行预防的患者中，11例患者的寄生虫血症仍为阳性。尽管这11例患者的寄生虫计数较高，但统计学上差异不显著，P>0.05。
该研究记录了苏丹中部产妇中疟疾寄生虫血症和贫血的高患病率。有533名孕妇（97％）未使用氯喹片进行化学预防，17名（3％）进行了预防。后者中的11名（N = 17）寄生虫血症呈阳性。鉴于寄生虫血症和贫血的高患病率，尽管使用氯喹片进行预防且寄生虫血症呈阳性的患者样本较小（550例中的17例），但建议进行大规模的预防安慰剂对照试验，以测试预防性药物在孕期的影响，并衡量对母亲和新生儿的效果。被证明有效的预防性药物应作为产前护理的一部分，与铁和叶酸一起作为抗贫血治疗。此外，建议及时用适当的抗疟药物治疗疟疾感染，喷洒杀虫剂，并使用浸有杀虫剂的蚊帐和窗帘来预防疟疾。
